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STIs and Genital Infections Flashcards

1
Q

List common bacterial STIs

A

Chlamydia
Gonorrhoea
Mycoplasma genitalium
Syphilis

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2
Q

List common viral STIs

A

Genital warts - HPV
Genital herpes
Hepatitis and HIV

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3
Q

List common parasitic STIs

A

Trichomonas vaginalis
Pubic lice - Phthirus pubis
Scabies

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4
Q

Why does gonorrhoea produce purulent discharge

A

Generally they produce an intense neutrophil response in the male urethra

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5
Q

Coinfections of STIs are common - true or false

A

STI pathogens move together
Gonorrhoea and chlamydia cause urethritis
Genital ulcers greatly increase the probability of HIV acquisition.

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6
Q

Is it normal to find bacteria in the vagina

A

Yes it has a normal flora
Lactobacillus spp. predominate and are protective
Strep and candida are normal in small numbers

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7
Q

What are some predisposing factors for candida infection

A

Recent antibiotic therapy
High oestrogen levels (pregnancy, certain types of contraceptives)
Poorly controlled diabetes
Immunocompromised patients - CD4 counts below 100 are predisposed to this
condition

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8
Q

How does a candida infection present

A

Intense itch

White vaginal discharge - like cottage cheese

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9
Q

How do you diagnose a candida infection

A

Often just clinical

Can do a high vaginal swab for culture

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10
Q

How do you treat a candida infection

A

Topical clotrimazole cream - treats external symptoms
Clotrimazole pessary
Oral fluconazole

Non-albicans Candida species
More likely to be azole resistant

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11
Q

How does candida balanitis present

A

Spotty rash on the penis

Not sexually transmitted

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12
Q

How does gonorrhoea affect cells

A

Attaches to host epithelial cells and is endocytosed into the cell
It replicates within the host cell and is released into the sub epithelial space

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13
Q

Where does gonorrhoea usually infect

A

Urethra
Rectum
Throat and eyes
Endocervix in females

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14
Q

Describe Neisseria gonorrhoea

A

Gram negative diplococcus
Often appear intracellularly as easily phagocytised
Looks like 2 kidney beans facing each other
Doesn’t survive well outside the body

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15
Q

How do you test for gonorrhoea

A

Gram stain and microscopy of urethral/endocervical swabs - done at sexual health clinic to confirm/exclude presence

NAAT testing carried out on swab (female) or first void urine sample (male)

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16
Q

What is a Nucleic acid amplification test

A

Test for chlamydia and gonorrhoea
Test first pass urine specimens from men and self-obtained vaginal swabs
More sensitive than culture

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17
Q

What is the most common bacterial STI in the UK

A

Chlamydia

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18
Q

Where does chlamydia usually infect

A

Urethra
Rectum
Throat and eyes
Endocervix

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19
Q

How do you treat chlamydia

A

Doxycycline 100mg bd x 7 days

Less commonly Azithromycin (1g oral dose)
If pregnant or at risk of pregnancy then azithromycin, erythromycin or amoxicillin may
be used.

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20
Q

Can chlamydia be gram stained

A

No

There is no peptoglycan in the cell wall so it wont stain

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21
Q

Can chlamydia reproduce outside a host cell

A

No

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22
Q

What are the 3 serological groups of chlamydia

A

Serovars A-C = Trachoma (eye infection) (NOT an STI)

Serovars D-K = Genital infection

Serovars L1-L3 = Lymphogranuloma venereum (tropical and MSM)

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23
Q

What type of urine sample must be used for a NAAT STI test

A

First pass only

Used to test male patients

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24
Q

How does trichomonas vaginalis present

A

Vaginal discharge (yellowish, frothy)
Vulvovaginitis: itch/discomfort
Strawberry cervix (microhaemorrhages)
Vaginal pH > 4.5

Men are usually asymptomatic but may get urethritis

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25
Q

What is trichomonas vaginalis

A

Single celled protozoal parasite
Human host only
transmitted by sexual contact

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26
Q

How do you diagnose trichomonas vaginalis

A

High vaginal swab for microscopy

PCR test available but not used in tayside

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27
Q

How do you treat trichomonas vaginalis

A

Oral metronidazole for 5-7 days

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28
Q

Describe the discharge seen in bacterial vaginosis

A

Homogenous and may contain bubbles
Grey/white in colour
Fishy odour - offensive

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29
Q

How do you test BV discharge

A

Adding 10% potassium hydroxide to the discharge on the slide elicits an amine-like, fishy odour, yielding a positive “whiff” test

A wet mount of the sample from the vagina will show
clue cells.
The absence of bacilli and their replacement
with clumps of coccobacilli also leads to the diagnosis

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30
Q

What are the potential complications of BV

A

increased rate of upper tract infection (endometritis, salpingitis)
Premature rupture of the membranes and preterm delivery
Increased risk for the acquisition of HIV

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31
Q

How do you treat BV

A

Metronidazole oral for 7 days

Relapse rate is 30%

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32
Q

How can you diagnose syphilis

A

Can do PCR test of swab from lesions
Dark Field Microscopy - not done in tayside
Doesn’t gram stain and cant be grown in culture

Or serological blood tests can be done as a screening test

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33
Q

How many stages does syphilis have

A

Primary lesion/infection - up to 3 months
Secondary stage - up to 2 years
Latent stage
Late stage

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34
Q

Describe primary syphilis

A

Presents with painless lesion (chancre) at inoculation site
Will have non-tender local lymphadenopathy
Organism multiplies at site and gets into bloodstream
Chancre heals

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35
Q

Describe secondary syphilis

A

Large number of bacteria circulating in the blood
Multiple manifestations at different sites
Snail-track” mouth ulcers, generalised rash,
generalised lymphadenopathy, flu-like symptoms, pharyngitis,
patchy alopecia etc.
Neurological and ophthalmic
involvement not uncommon

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36
Q

Describe latent stage syphilis

A

No symptoms, but low-level multiplication of spirochaete in intima of small blood vessels
Some patients will self-cure or
be treated inadvertently

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37
Q

Describe late stage syphilis

A

Cardiovascular or neurovascular complications many years later

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38
Q

How do you diagnose syphilis

A

Primary : dark ground microscopy, PCR, IgM

Secondary: serology ( specific and nonspecific)
Tertiary : serology (non-specific antibodies first then specific test TPPA done if positive)

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39
Q

How do you treat syphilis

A

It is very sensitive to penicillin
Injectable long-acting preparations of penicillin used for treatment - IM
1 injection in early disease and 3 if late

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40
Q

What causes genital herpes

A

Herpes simplex virus type 1 (which also causes “cold sores”) and type 2
More commonly type 2

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41
Q

How is genital herpes spread

A

Transmitted by close contact with someone shedding the virus

Spread by either genital/genital or oropharyngeal/genital contact

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42
Q

How does genital herpes affect the body

A

Virus replicates in dermis and epidermis
Gets into nerve endings of sensory and autonomic nerves
Nerve endings get inflamed and you get small vesicles - easily deroofed
Virus migrates to the root ganglion and hides from immune system - becomes latent
Can reactivate from here causing recurrent genital herpes

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43
Q

How do you diagnose genital herpes

A

Swab in virus transport medium of deroofed blister for PCR test – highly sensitive and specific test

No good test for inactive infection

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44
Q

How do you treat genital herpes

A

Aciclovir may be helpful if taken early enough
Pain relief - topical lidocaine or analgesia
Saline bathing

Avoid sexual contact until episode is over

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45
Q

How are pubic lice spread

A

Acquired by close genital skin contact

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46
Q

How do pubic lice present

A

Lice bite skin and feed on blood, which causes itching in pubic area

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47
Q

How do you treat pubic lice

A

malathion lotion

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48
Q

How do you treat gonorrhoea

A

IM ceftriaxone (1g) first line

Cefixime 400 mg oral and azithromycin 2g oral
Test of cure needed for all patients

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49
Q

How long do you have to wait for a test of cure for gonorrhoea

A

5 weeks

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50
Q

Do you need to treat sexual partners of patients who present with thrush

A

Only if they show symptoms

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51
Q

How does genital herpes present

A 
Small blisters on the genitals - vesicles which then become pustular
Extremely painful 
Vulval inflammation 
Difficulty passing urine 
 Local lymphadenopathy
Fever and myalgia
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52
Q

How do you treat genital warts

A

Cryotherapy

Topical:
Podophyllotoxin cream
Imiquimod (Aldara)- immune modifier

Electrocautery
Curettage
Excision

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53
Q

Can chlamydia be asymptomatic

A

YES

70-80% of women, 50% of men are asymptomatic

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54
Q

How is chlamydia spread

A

Vaginal, oral or anal sex
Or genital contact with an infected partner

Pregnant women can pass on the infection to infants during birth

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55
Q

What are the complications of untreated chlamydia

A

PID
This increases the risk of chronic pain, ectopic pregnancy and tubal factor infertility

Adhesions can form

Epididymo-orchitis and proctitis in men

Reactive arthritis, conjunctivitis and urethritis are a common triad - Reiter’s syndrome

Babies can also get pneumonitis and eye infection due to chlamydia

Fitz-Hugh-Curtis Syndrome (Perihepatitis)

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56
Q

How does chlamydia present in women

A 
Post coital or intermenstrual bleeding
secondary dysmenorrhoea
Lower abdominal/pelvic  pain
Deep dyspareunia
Mucopurulent cervicitis - discharge 
Dysuria 
Rectal pain and/or discharge

Can be asymptomatic!

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57
Q

How does chlamydia present in men

A 
Urethral discharge - clear and milky 
Dysuria
Urethritis
Epididymo-orchitis
Proctitis

Can be asymptomatic!

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58
Q

What is LGV

A

Lymphogranuloma venereum

Serovars of Chlamydia - more invasive and gives more disease

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59
Q

Who is most likely to get LGV

A

Men who have sex with men

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60
Q

How does LGV present

A

Rectal pain, tenesmus discharge and bleeding - proctitis
Can look like Crohn’s

High risk of concurrent STIs (67% HIV)

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61
Q

How do you diagnose chlamydia

A

Test 14 days following exposure if asymptomatic - due to incubation period

NAAT- females (vulvovaginal swab), males (first void urine or urethral swab)
MSM (add rectal swab if has receptive anal intercourse and pharyngeal)

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62
Q

Describe mycoplasma genitalium infection

A

Emerging STI
Often asymptomatic
Diagnose with the NAAT test
Tested if people fail treatment for PID and NGU

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63
Q

How long do you have to wait to test for gonorrhoea

A

Incubation time is 2-5 days

Still advised to wait 14 days as its in the same test as chlamydia (which has longer incubation)

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64
Q

How does gonorrhoea present in men

A 
Can be asymptomatic 
Urethral discharge -green/yellow mucopurulent 
Dysuria 
Testicular pain 
Pharyngeal/rectal infections
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65
Q

How does gonorrhoea present in women

A 
Asymptomatic (up to 50%)
Increased/altered vaginal discharge 
Dysuria
Intermenstrual/post-coital bleeding
Cervicitis 
Pelvic pain
Pharyngeal and rectal infection are usually asymptomatic.
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66
Q

What are some of the complications of gonorrhoea

A

Bartholintiis or tysonsitis - infected genital glands
Bartholin’s abscesses
PID - can lead to ectopics and infertility
Hydrosalpinx
Urethral strictures
Epididymo-orchitis
Proctocolitis resulting in strictures, abscesses and fistulae

Infection can become disseminated and lead to septic arthritis etc.

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67
Q

Which infection is more likely to cause severe complications - chlamydia or gonorrhoea

A

Chlamydia

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68
Q

What is the difference between a primary herpes episode and non-primary episode

A

Primary – never been exposed to herpes before

Non-primary – have been exposed to the virus before (have antibodies) but this is the first symptomatic presentation

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69
Q

Which type of herpes virus is most likely to cause recurrent infections

A

HSV type 2

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70
Q

How and when should you suppress herpes

A

Suppression needed if they have 6 or more attacks per year

Aciclovir 400mg bd is given for 12 months – should stop recurrence for that year

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71
Q

What is the risk of herpes in pregnancy

A

Risk of giving it to the baby and it can spread to their brain
Less worrying if they’ve had herpes before as they will have antibodies that will be passed on to babies

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72
Q

What are the high risk types of HPV

A

16, 18,

Also 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68

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73
Q

Which types of HPV are vaccinated against

A

6, 11, 16, 18

Adding 31, 33, 45, 52, 58

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74
Q

Is HPV common

A

VERY
80% of populations are exposed at some point
Very few go on to develop warts - around 1%

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75
Q

Do all warts need treated

A

About 20% will spontaneously clear
Most need treatment
20% will not respond to treatment

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76
Q

How is syphilis transmitted

A

Sexual contact
Trans-placental/during birth
Blood transfusions
Non-sexual contact – healthcare workers

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77
Q

When is syphilis screened for outside the SRH clinic

A

Pregnant women - screened at 8-12 weeks

Blood donations

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78
Q

What is chemsex

A

Drugs are used to prolong and enhance sex

Higher risk of having multiple partners and trauma which increases infection risk

79
Q

Why is early detection of HIV important

A

Allows us to prevent AIDS

Treatment can lead to normal life expectancy

80
Q

How does AIDS kill

A

Opportunistic Infections - pneumonias, fungal infections

AIDS-related cancers - Kaposi

81
Q

Where did HIV originate

A

In primates in West-Africa

Spread to humans in the 1930’s/40’s

82
Q

Which cells does HIV target

A

HIV infects cells with CD4+ surface glycoprotein
It targets the receptors

This includes T helper lymphocytes, dendritic cells, macrophages and microglial cells
Lymphocytes are the main ones affected

83
Q

What type of virus is HIV

A

Retrovirus - type of RNA virus

Meaning when it makes DNA it uses reverse transcriptase to turn single stranded RNA to DNA

84
Q

What effect does HIV have on the immune response

A

Reduces circulating CD4 cells by sequestration of cells in lymphoid tissues
Reduced proliferation of CD4+ cells
Reduction CD8+ (cytotoxic) T cell activation– makes you more susceptible to opportunistic infection
Reduction in antibody class switching - less effective antibodies produced
In a constant state of immune activation

85
Q

What does HIV make you more susceptible to

A

Viral infections
Fungal infections
Mycobacterial infections
Infection-induced cancers

86
Q

At what CD4+ count do become at risk of opportunistic infection

A

200 cells/mm3

Normal is 500-1600 cells/mm3

87
Q

How quickly does HIV replicate

A

Very rapidly in early and very late infection
New generation every 6-12 hours
Reverse transcriptase works very fast to produce new virus – doesn’t go through the same rigorous checking as normal DNA

88
Q

How does HIV infect the body

A

Enters the body across a mucosa - usually via sexual intercose
Infection of mucosal CD4 cell - often dendritic cells which are found here
Infected cells are transported to regional lymph nodes
Here the virus spreads rapidly and infects other cells at the lymph nodes such as T helper cells
and macrophages
Infection established within 3 days of entry
Dissemination of virus

89
Q

What is the window period for giving post-exposure prophylaxis for HIV

A

72 hours

After this time the infection is too well established to prevent

90
Q

How does primary HIV infection present

A

Up to 80% present with symptoms around 2-4 weeks after infection
Combination of fever, rash (maculopapular), myalgia, pharyngitis, headache/aseptic meningitis
Flu like or glandular fever like illness – more than a cold

91
Q

Is transmission high in the primary infection of HIV

A

Yes very high at this stage of illness

This is because there is a big spike in the amount of virus in the blood at this point

92
Q

What is the definition of an opportunistic infection

A

An infection caused by a pathogen that does not normally produce disease in a healthy individual. It uses the “opportunity” afforded by a weakened immune system to cause disease

93
Q

List some opportunistic infections that may be a sign of HIV

A 
Toxoplasmosis 
Pneumocystis pneumonia 
TB 
CMV
Herpes zoster or simplex 
HPV
94
Q

Describe toxoplasmosis infection

A

Caused by Toxoplasma gondii.
Lots of people exposed as cats have it but doesn’t usually make us ill
Leads to multiple cerebral abscess
Presents with headache, fever, focal neurology, seizures, reduced consciousness and raised ICP

95
Q

How does pneumocystis pneumonia present

A

Insidious onset
SOB and dry cough
Exercise desaturation = Exercise for 5 mins and sats will often plummet
CXR can be normal – often looks more like heart failure than consolidation

96
Q

How do you diagnose pneumocystis pneumonia

A

Bronchial-alveolar lavage and immunofluorescence

+/- PCR

97
Q

How do you treat pneumocystis pneumonia

A

High dose co-trimoxazole (+/- steroid)

Lower dose can be used for prophylaxis for all patients with CD4 <200

98
Q

Describe CMV infection

A

Also a very common virus
Can reactivate if you become immunosuppressed
Causes retinitis, colitis, oesophagitis
Presents with reduced visual acuity, floaters, abdo pain, diarrhoea, PR bleeding

99
Q

Why do women with HIV need annual cervical screens

A

They are at a much higher risk of HPV causing dysplasia

100
Q

Can HIV cause neurological problems

A

Yes
HIV itself is a neurotoxic agent
Leads to reduced short term memory and motor dysfunction
Also makes you more susceptible to neurological infections

101
Q

What is progressive multifocal leukoencephalopathy

A 
Neurological condition caused by JC virus 
Seen in immunosuppression - CD4 <100
Rapidly progressing
Focal neurology
Confusion
Personality change
102
Q

What is slim’s disease

A

HIV associated cachexia

May be caused by metabolic dysfunction, anorexia, malabsorption and hypogonadism

103
Q

What is Kaposi’s sarcoma

A

An AIDs related vascular tumour
Caused by human herpes virus 8
Can occur at any CD4 but more common as you decline
Tumours can be cutaneous, mucosal or visceral – pulmonary, GI

104
Q

How do you treat Kaposi’s sarcoma

A

HAART
Local therapies
Systemic chemotherapy

105
Q

Name the AIDS-related cancers

A

Kaposi’s sarcoma
Non-Hodgkin’s lymphoma
Cervical cancer

106
Q

What causes non-Hodgkin’s lymphoma in AIDS

A

EBV - higher incidence with immunosuppression

107
Q

List some general symptoms of HIV infections

A 
Mucosal candidiasis
Seborrhoeic dermatitis
Diarrhoea
Fatigue
Worsening psoriasis
Lymphadenopathy
Parotitis
Epidemiologically linked conditions
(STIs, Hep B and C)
108
Q

List some of the haematological manifestation of HIV

A

Anaemia
Thrombocytopenia
Neutropaenia
Lymphopaenia

109
Q

What factors increase risk of sexual transmission of HIV

A

Anoreceptive sex
Trauma
Genital ulceration
Concurrent STI

110
Q

How is HIV transmitted

A 
Sex - 95% of new infections 
Injection drug use - sharing needles 
Infected blood products - rare now 
Iatrogenic  
Mother to child
111
Q

How can a mother pass HIV onto her child

A

In utero/trans-placental
Delivery
Breast-feeding
Without treatment the ¼ will be infected and 1/3 will die before age of 1

112
Q

Where is HIV most prevalent

A

Africa - particularly sub-Saharan

113
Q

Which societal groups are most affected by HIV

A

Men who have sex with men
Female partners
of bisexual men
Black African men and women
People who inject drugs - shaare needles
Partners of people
living with HIV
Adults, children and those with sexual partners
from endemic areas
Children born to HIV+ or untested mothers from endemic areas

114
Q

Who should be tested for HIV

A

Universal testing in high prevalence areas
Screening of high risk groups
Testing in the presence of “clinical indicators”
Opt-out testing at GUM clinics,, TOP services, antenatal services, assisted conception services

115
Q

How do you take an HIV test if the patient is incapacitated

A

Only test if in patient’s best interest
Consent from relative not required
If safe, wait until patient regains capacity
Obtain support from HIV team if required

116
Q

Which markers of HIV can be used to detect infection

A

Viral RNA
Antigens - fastest
Antibodies - take up to 3 months to appear

117
Q

What is the window period for a 4th generation HIV test

A

14-45 days
Combined antibody and antigen test
Carried out on blood sample

118
Q

How quick are the rapid HIV tests

A

Fingerprick blood specimen or saliva

Results within 20-30 minutes
Can be 3rd generation tests which are antibody only, whereas 4th are antigen/antibody

119
Q

What are the advantages of rapid HIV tests

A 
Simple to use
No lab required
No venepuncture required
No anxious wait
Reduce follow-up
Good sensitivity
120
Q

What are the disadvantages of rapid HIV tests

A 
Expensive ~£10
Quality control
Poor positive predictive value in low prevalence settings
Not suitable for high volume
Can’t be relied on in early infection
121
Q

List some targets for anti-retroviral drugs

A

Enzymes:
Reverse transcriptase
Integrase
Protease

Can also block entry and maturation of the virus

122
Q

What is involved in highly active anti-retroviral therapy (HAART)

A

A combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

123
Q

List examples of HIV drugs

A

Tenofovir
Emtricitabine
Efavirenz
Nevirapine

124
Q

What are some of the side effects of highly active anti-retroviral therapy

A 
GI side effects 
Skin rashes, hypersensitivity
Steven Johnsons
Mood changes 
Psychosis 
Renal toxicity 
Osteomalacia 
Increased MI risk 
Anaemia
125
Q

Is partner notification compulsory

A

No its voluntary
Can take a long time to contact people
Can be done by the clinician with patient consent

126
Q

How can you prevent HIV transmission

A 
Condom use
HIV treatment
STI screening and treatment
Disclosure 
Post-exposure prophylaxis
Pre-exposure prophylaxis
127
Q

How can you prevent transmission of HIV from mother to child

A 
HAART during pregnancy
Vaginal delivery if undetected viral load
Caesarean section if detected viral load
4/52 PEP for neonate
Exclusive formula feeding
128
Q

What conception options are there for a HIV+ man and a negative female partner

A

Treatment as prevention

PrEP for partner

129
Q

What conception options are there for a HIV+ woman and a negative male partner

A

Treatment as prevention
Artificial or self insemination
PrEP for partner

130
Q

What is the eligibility criteria for PrEP

A 
Age over 16 
HIV negative 
Can commit to 3/12’ly follow-up
Willing to stop if eligibility criteria no longer apply 
Resident of Scotland

Given to high risk groups or people with HIV+ partners

131
Q

How can we prevent HIV

A 
Condom programmes 
Behavioural change programmes 
Treatment and support of those living with HIV 
Increase uptake of testing 
Prevent children being born with HIV
132
Q

What are the roles of the sexual health clinic

A 
Diagnosis and management of STIs
Partner notification
Infection prevention
Genital dermatology
Contraception
Community gynaecology
Menopause
Psychosexual counselling
133
Q

Which infections do not need partner notification

A

Warts
Herpes
Vaginal thrush
BV

134
Q

What is the partner notification look back period for gonorrhoea

A

Male urethral - 2 weeks

Any other - 3 months

135
Q

What is the partner notification look back period for HIV

A

4 weeks before a previous negative test or before most likely time of infection

136
Q

What is the partner notification look back period for chlamydia

A

Male with symptoms- 4 weeks prior to symptom onset

Any other patients - 6 months

137
Q

What is the partner notification look back period for syphilis

A

Primary - 90 days
Secondary - 2 years
Other infection - 3 months prior to negative test

138
Q

Who gets vaccinated against Hep B

A 
MSM
High prevalence countries (travellers)
Sexual assault
Contacts 
Healthcare workers
139
Q

Who gets vaccinated against Hep A

A

MSM

140
Q

What drugs are used in PrEP

A

Tenofovir disoproxil / emtricitabine

141
Q

How is PrEP taken

A

Medicine taken before exposure to HIV to reduce risk of infection
Can be taken on daily or event-based basis
Given to high risk patients

142
Q

What infections have post-exposure prophylaxis available

A

Hep B - vaccine can be given up to 7 days later

HIV - anti-retrovirals given within 72hrs for 28 days

143
Q

What treatment is needed for a recent rape victim

A 
Consider forensic examination
Immediate safety
Injuries
Emergency contraception 
HBV vaccination
HIV PEP 
STI/pregnancy care
Counselling
144
Q

What are the risk factors for gender-based violence

A 
Being female 
Disability 
Pregnancy 
Addictions 
HIV
145
Q

How long should you abstain from sex after a chlamydia diagnosis

A

At least 2 weeks

146
Q

When would you test for chlamydia

A

If they have symptoms - urethritis, pain etc.
If they have been contact traced
If they have any other STI
Asymptomatic screening in high risk groups

147
Q

When would you test for gonorrhea

A

If they have symptoms - urethritis, pain etc.
If they have been contact traced
If they have any other STI
Asymptomatic screening in high risk groups

148
Q

What is the testing window period for syphilis

A

Test only accurate 3 months after sexual contact

149
Q

What is the testing window period for HIV

A

Confirmed after 45 days

Can get a good indication after 4 weeks with a 4th generation test - commonly used

150
Q

Which STI tests would be offered to a man who has sex with men in a general screen

A
  • First pass urine sample for chlamydia and gonorrhoea (tested by NAAT testing)
    Rectal swab for chlamydia and gonorrhoea (NAAT)
    Pharyngeal swab for chlamydia and gonorrhoea (NAAT)
    Blood sample for HIV and syphilis
    Also test for Hep B - bloods
151
Q

How is Hep B tested for

A

Blood test
You would test for core antibody first line which would be positive in both past and current infection.
If it was positive then surface antigens are tested as these would be positive in a current infection only.

152
Q

Which vaccinations are offered to MSM

A

HPV

Hep B and Hep A

153
Q

Chlamydia is most common in which population groups

A

Mainly in young men and
women aged under 25.
Higher incidence in females than males in Scotland.

154
Q

Do you need a test of cure for chlamydia

A

No
Unless the patient is pregnant, there is a risk of reinfection or
the treatment compliance is in question.
A test of cure is routine for rectal infections.

155
Q

When would you treat men empirically for trichomonas

A

If they have recurrent/persistent non-chlamydial, non-gonococcal urethritis

Male contacts of affected women are also treated.

156
Q

Which types of HPV cause genital warts

A

Type 6 and 11

157
Q

How do genital warts present

A

Non-painful, non-pruritic genital lumps

158
Q

Do you need a test of cure in syphilis

A

Yes
RPR (rapid plasma reagin) –essential for
monitoring response to therapy, often never
becomes negative
Test for RPR for 12 months to ensure a four-fold reduction

159
Q

What causes syphilis

A

Caused by coiled spirochete bacterium Treponema pallidum

160
Q

How does genital herpes present

A 
Blistering ulcer(s) at external genitalia
Pain
External dysuria
Vaginal or urethral discharge
Local lymphadenopathy
Fever and myalgia
161
Q

Which type of herpes virus is more likely to cause recurrent herpes

A

HSV2

162
Q

How does recurrent herpes present

A 
Mild
anogenital tingling, burning or itching
Usually unilateral small vesicles or ulcers which heal with scabbing on keratinised
skin.
Minimal systemic symptoms
Recurrences last up to 7 days
163
Q

Which species of candida is most likely to cause thrush

A

C. albicans

164
Q

How does prostatitis present

A

Symptoms of UTI,
Lower abdominal pain/back/perineal/penile pain
Obstructive voiding symptoms
Fever and rigors

Digital rectal examination will reveal a tender, boggy prostate gland

165
Q

What causes prostatitis

A

Usually caused by E. coli, other coliforms and Enterococcus sp.

May also (very uncommonly) be caused by gonorrhoea or chlamydia
Therefore, men under the age of 35 presenting with prostatitis should be screened for STIs.
166
Q

List risk factors for prostatitis

A 
Recent a urogenital procedure
Recent prostate biopsy
Intermittent
bladder catheterisation
Recent urinary tract infection (rare)
167
Q

How do you diagnose prostatitis

A

MSSU for culture and sensitivity
(+/- first pass urine for chlamydia/gonorrhoea
tests)

168
Q

Acute bacterial prostatitis can progress to what

A

Chronic bacterial prostatitis (<5% of cases) or Chronic prostatitis/chronic pelvic pain
syndrome (CP/CPPS)

169
Q

How do you treat prostatitis

A

ofloxacin 400mg bd for 28 days

170
Q

If a MSM presents with prostatitis what other test should be done

A

Should also been screened for rectal gonorrhea

171
Q

Is bacterial vaginosis an STI

A

NO
However, it is almost exclusively seen among
sexually active women and more frequent where other risks for STIs exist.
It is more
common in women whose sexual partners are women.

172
Q

How does BV affect the vaginal pH

A

It is usually found to be >4.5

This due to the
overgrowth of anaerobic organisms leading to a
consequent fall in lactic acid producing aerobic
lactobacilli resulting in a raised vaginal pH

173
Q

Large numbers of leukocytes in the wet mount of a woman with BV suggest what

A

A coincident

infection, possibly trichomoniasis or bacterial cervicitis

174
Q

What is the most common cause of BV

A

Gardnerella vaginalis, a species of anaerobic bacteria

175
Q

List risk factors for blood borne viruses

A

Current or past history of history of injecting
drugs
Sex with a partner from or in a country with
a high HIV or Hep B prevalence
MSM or women who have had sex with HSM
If they have ever exchanged
money in return for sex
Medical treatment / tattooing where sterility
cannot be guaranteed

176
Q

Which STIs require partner notification

A

HIV

  • Gonorrhoea
  • Chlamydia
  • Trichomoniasis
  • Syphilis
  • Lymphogranuloma venereum
  • Pelvic inflammatory disease
  • Hepatitis A, B and C
  • Epididymo-orchitis
  • Mycoplasma genitalium
  • Non-gonococcal urethritis
177
Q

Which type of HIV is more likely to progress to AIDS

A

HIV-1

HIV-2 is rarer

178
Q

Can someone be immune to HIV

A

YES
Some
people have mutations in the CCR5 co-receptors which are used by HIV to enter the cell
This means they are immune to infection by a
CCR5-using virus.
If the mutation is homozygous, they are immune, if its heterozygous the disease will slowly progress.

179
Q

At which stage of infection does the immune system start to act against HIV

A 
It kicks in and lowers levels of the virus in the blood by
12 weeks (still detectable). At this point the patient enters the chronic and clinically asymptomatic phase (lasting between 2-10 years)
180
Q

Describe the chronic phase of HIV infection

A

The body’s immune system lowers the viral load after around 12 weeks
The patient becomes clinically asymptomatic
Virus would still be detectable on testing
This phase can last between 2-10 years
During this chronic phase T cells may have a level
of >500 cells/mm3 however this is still enough to fight infection

181
Q

List some respiratory manifestations of HIV

A

Respiratory tuberculosis
Pneumocystis Pneumonia
Aspergillosis
Bacterial pneumonia

182
Q

List some GI manifestations of HIV

A 
Persistent cryptosporidiosis
Oral and oseophageal candidiasis
Oral hairy leukoplakia
Chronic diarrhoea of unknown cause
Weight loss of unknown cause
Salmonella, shigella or campylobacter
Hepatitis B infection
Hepatitis C infection
183
Q

List some neurological manifestations of HIV

A 
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
HiV-associated neurocognitive impairment - reduced short-term memory with/without motor dysfunction
Aseptic meningitis /encephalitis
Primary cerebral lymphoma
Cerebral abscess
Cryptococcal meningitis
Space occupying lesion of unknown cause
Guillain–Barré syndrome
Transverse myelitis
Distal sensory polyneuropathy
Mononeuritis multiplex
Vacuolar myelopathy
Neurosyphilis
184
Q

List some dermatological manifestations of HIV

A

Kaposi’s sarcoma
Severe or recalcitrant seborrhoeic dermatitis
Severe or recalcitrant psoriasis
Multi-dermatomal or recurrent herpes
zoster
HPV- huge warts with increasing tendency for dysplasia

185
Q

Which cancers can be associated with HIV

A

Non-Hodgkin’s lymphoma
Kaposi sarcoma
Anal cancer or anal intraepithelial dysplasia
Lung cancer
Seminoma
Head and neck cancer
Hodgkin’s lymphom
Multi-centric Castleman’s disease (HHV8-mediated)
Cervical cancer
Vulval intraepithelial neoplasia
Cervical intraepithelial neoplasia grade 2 or above

186
Q

List some manifestations of HIV seen in the eyes

A

Cytomegalovirus retinitis - leads to reduced acuity, floaters, abdo pain, diarrhoea and PR bleeding

Infective retinal diseases including herpesviruses and
toxoplasma
Any unexplained retinopathy

187
Q

List some ENT manifestations of HIV

A

Lymphadenopathy of unknown cause
Chronic parotitis
Lymphoepithelial parotid cysts

188
Q

What follow up is required for someone who has taken HIV PEP

A

Patients taking HIV PEP should have a 4th generation HIV
test (along with syphilis, HBV and HCV serology) and have
appropriate biochemistry tests, renal and liver function tests
done.

They should be advised to have:
• A single follow-up HIV test 8-12 weeks after exposure, using a 4th generation test
• To practise safer sex (condom use)

189
Q

What are the Fraser Guidelines used for

A

To give contraceptive advice and treatment to a young person under the age of 16 without their parent’s knowledge

Only if they have the maturity and intelligence to give fully informed consent, cannot be persuaded to tell a parent, likely to have sex anyway, if it is in their best interest

190
Q

How old do you have to be to consent to sexual activity in the UK

A

16
Some under 16s will have consensual sex (both must be competent and under 16) but must check for safeguarding
A child who has not yet reached the age of 13 is
incapable of consenting to any form of sexual activity

191
Q

What is the definition of sexual assault

A

If a person (“A”) performs any sexual activity—
•without another person (“B”) consenting, and
•without any reasonable belief that B consents

192
Q

Which sexual acts are considered sexual assault in Scotland (if done without consent)

A

Penetration - vagina, anus or mouth
Intentionally or recklessly touching sexually
Engaging in any other form of sexual activity in which the perpetrator intentionally or recklessly,
has physical contact (whether bodily contact or contact by means of an implement and
whether or not through clothing)
Intentionally or recklessly ejaculates semen onto someone
Intentionally or recklessly emits urine or saliva onto someone sexually.

193
Q

What is the window for collecting forensic evidence in cases of sexual assault

A 
7 days (168 hours) to capture DNA and bodily
fluids
194
Q

In order to avoid losing evidence in cases of sexual assault what should you do

A

Avoid:
• Bathing, showering, washing
• Douching
• Washing clothes worn at the time of the assault
• Urinating until after a forensic examination if choosing to have forensic capture

Preserve:
• Underwear and clothes worn at the time of the incident
• Sanitary pads/tampons worn at the time
• Condoms
• Retain tissue used to wipe after urinating

Reproduction (16 decks)

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